title: Rhabdomyolysis after liver transplantation: a case report.
abstract: Our aim was to present the case of a pediatric biliary atresia patient who experienced rhabdomyolysis with severe cardiac arrhythmias associated with hyperkalemia, metabolic acidosis, and myoglobulinemia during liver transplantation. A 5-year-old girl, weighing 16.5 kg, with end-stage liver disease due to biliary atresia underwent living donor liver transplantation. A sudden onset of atrial fibrillation with rapid ventricular response was noted during the transplantation. The cardiac arrhythmia was associated with hyperkalemia, metabolic acidosis, and myoglobulinemia. Rhabdomyolysis was suspected. Hyperkalemia and metabolic acidosis were not corrected despite treatment with 10 mL of 50% glucose plus 6 U of regular insulin in 4 succeeding boluses and 110 mEq sodium bicarbonate before sending the patient to the intensive care unit. A corresponding decrease and normalization in serum potassium and correction of metabolic acidosis were noted as responses to a single dose of intravenous (20 mg) dantrolene. The patient was extubated 5 days after transplantation. The kidney function remained within normal limits during the rhabdomyolysis and the entire hospital stay. The patient was discharged 7 weeks later and is surviving with the original liver graft and satisfactory kidney function to date.
authors.affiliation: Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Huang
authors.forename: C-L
authors.initials: CL
authors.lastname: Chen
authors.forename: C-S
authors.initials: CS
authors.lastname: Wang
authors.forename: K-W
authors.initials: KW
authors.lastname: Cheng
authors.forename: K-H
authors.initials: KH
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Wang
authors.forename: A M
authors.initials: AM
authors.lastname: Concejero
authors.forename: Y-F
authors.initials: YF
authors.lastname: Cheng
authors.forename: T-L
authors.initials: TL
authors.lastname: Huang
authors.forename: K-W
authors.initials: KW
authors.lastname: Chiu
authors.forename: S-H
authors.initials: SH
authors.lastname: Wang
authors.forename: C-C
authors.initials: CC
authors.lastname: Lin
authors.forename: Y-W
authors.initials: YW
authors.lastname: Liu
authors.forename: B
authors.initials: B
authors.lastname: Jawan
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D001656:Biliary Atresia / Q000601:surgery*; D002675:Child, Preschool; D003620:Dantrolene / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D009211:Myoglobin / Q000378:metabolism; D011183:Postoperative Complications; D012206:Rhabdomyolysis / Q000175:diagnosis* / Q000188:drug therapy; D017180:Tachycardia, Ventricular / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D009211:Myoglobin; D003620:Dantrolene